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everen <br />� <br />City of Everett <br />$�wer Application and Permit <br />N0. G4496 DATE __3/33/A3 <br />3127 RockRfnller ,/t� <br />Service Address_ <br />BillingAddress P•O. Box 1077 <br />Everutt, Na. 9920G <br />City, State, Zip <br />Owner �Mortgagor� ki).lia�a 6 rovak _ <br />Billing Name �illiams s Novack <br />Connection By <br />Address <br />259—�141 <br />DESCRIFTION: <br />Lot 8 __ Block 739 <br />PlatLver3tt Lnnd Company's lst <br />Unplatted Description <br />Tyoe PermiC Cap—ofP <br />Remarks: <br />Utility Account No._ <br />Permit Fee 2 • 50 <br />Connection Chargels�. <br />Total Fee_ � • 5 c <br />Signed <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />� Abut[ing Lot Line <br />N, S, E, W <br />SEE SKETCH ATTACHED <br />INSP[CTION <br />A. R. Theeal <br />Approved By <br />City Engincer <br />P.. fJon�l <br />Issued 8v <br />Inspection B <br />Date Inspect <br />No. 24496 <br />� <br />� <br />� <br />